Claire O'Connelltalks to the head of the first national cervical screening programme, which will be rolled in the coming weeks
MENTION THE words "smear test" to a woman and you are likely to be met with a grimace and a vague muttering about needing to go to have one done soon.
But cervical smear testing can save lives and in Ireland it is about to undergo a radical change thanks to CervicalCheck, a national programme that could cut deaths from cervical cancer here by up to 80 per cent.
"A smear test is a scraping of the cells at the neck of the womb to see if there are any cell changes that might be pre-cancerous or lead to cancer later on," explains Dr Marian O'Reilly, head of cervical screening with the National Cancer Screening Service, an agency of the Department of Health.
Until now, women living in most parts of the State have been offered smear tests in an ad hoc fashion, and have generally had to pay to visit a doctor or clinic for the service.
But over coming months, Ireland's first national cervical screening programme, called CervicalCheck, will be rolled out to offer free smear tests to women at defined and age-appropriate intervals.
"It's a screening test, it's not a diagnostic test," says O'Reilly.
"And with any screening test there are limitations, no screening test is 100 per cent effective, so the most important message about a smear test is that it is best delivered through a programme so that a woman has regular tests," she says. "There's very little value to a single test, it's about having regular tests at regular intervals."
About 200 new cases of cervical cancer are diagnosed in the Republic each year, and more than 70 women die here from the condition annually, but O'Reilly says international evidence suggests the new quality-assured and organised programme could eventually save 50-60 lives per year.
CervicalCheck will offer women aged 25-44 smear tests at three-yearly intervals, while women aged 45-60 will be eligible for a test every five years.
The intervals are based on average ages of diagnosis (mid-40s) and death (mid-50s) from cervical cancer in Ireland, explains O'Reilly.
"Cervical cancer takes 10-15 years to develop, so you have your window of opportunity in the Irish population before they reach what we know is the average age of diagnosis in the mid-40s," she says.
"So women should have come into the programme by the time they are 30, and with three-yearly screening up to 45 they are getting a risk reduction of 91 per cent of developing cervical cancer.
"And after that they move on to five-yearly screening, where risk reduction is of the order of 84 per cent."
And even if women have been vaccinated against Human Papilloma Virus (HPV), which is a known cause of cervical cancer, they will still need regular smear tests, explains O'Reilly.
"The two vaccines that are available on the market at the moment don't protect against all of the subtypes of the virus that cause cervical cancer. So successfully vaccinating children may prevent about 70 per cent of the cervical cancers caused by the particular subtypes the vaccine but it won't wipe out cervical cancer completely."
The move away from ad hoc or "opportunistic" screening, where the woman attends a clinic for another reason and is offered a smear test "while she's there" is also an important aspect of the programme to make way for a more standardised approach, says O'Reilly.
She notes that smear tests taken from ineligible women will not be read: "We are ceasing routine smear tests at the antenatal clinic or the postnatal tests. They were the opportunistic smear tests of the past. Now it's the programme or nothing."
An initial phase of the screening programme has been running in the midwest since 2000, and O'Reilly says that medical staff have "embraced it and made it work".
This month CervicalCheck has been organising paperwork with GPs and clinics around the State in advance of the countrywide rollout. And if women feel uncomfortable attending their own GP for the test, they can choose another centre that has registered with the free scheme, says O'Reilly.
"We know from research we have done with women about barriers for going for a smear test that the gender of the smear-taker is high on the list," she notes.
"Another one then is fear and embarrassment. And quite overarchingly internationally, cost is the biggest barrier to a woman having a smear test."
Recent advances in smear sample collection have reduced the number of unreadable tests which have to be repeated, according to O'Reilly.
The expected turnaround time for analysing the samples is about 10 days, and for the vast majority of women - an anticipated 90 per cent - the results of the screen will be negative, she adds.
However, the outsourcing of sample analysis to US company Quest Diagnostics has stirred up controversy: earlier this year doctors voiced concerns about the quality of the analysis, but the National Cancer Screening Service rejected their allegations.
O'Reilly also defends the decision to award the two-year contract to the US company: "There was a rigorous EU tender process and the selection at the end of that was Quest," she says.
And now with smear-takers and screeners readying up, the challenge is to get the estimated 1.1 million eligible women in Ireland onto the programme, says O'Reilly.
"Over the next five years we need about 80,000 women to go through the screening, otherwise we won't be effective in reducing cervical cancer in Ireland."
For more information on CervicalCheck visit www.cervicalcheck.ie (available from September 1st) or www.cancerscreening.ie.
You can also telephone the information line number on 1800 45 45 55